IT IS now established that nonthyroidal illness can alter thyroid hormone metabolism in such a way that the serum level of triiodothyronine (T3) is decreased and the level of reverse triiodothyronine (rT3) is elevated in otherwise euthyroid persons.1 The list of such nonthyroidal illnesses in which these findings occur has been growing. In patients with hyperthyroidism and intercurrent, nonthyroidal illness, the serum T3 level may be normal or even less than normal and there is a concomitant increase in the rT3 level.2-4 Although one recent report describes a patient with diabetic ketoacidosis, hyperthyroidism, and a normal T3 level,4 and another describes a patient in whom thyroid storm developed postoperatively and who at that time had a normal T3 level,5 the occurrence of thyroid storm in a patient with a normal T3 level and severe intercurrent illness has not been
Ahmad N, Cohen MP. Thyroid Storm With Normal Serum Triiodothyronine Level During Diabetic Ketoacidosis. JAMA. 1981;245(24):2516–2517. doi:10.1001/jama.1981.03310490034021
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